The role of nuclear medicine techniques; Tc-99m-labeled dimercaptosuccinic acid, diethylenetriaminepentaacetic acid, and mercaptoacetyltriglycine scintigraphies in pediatric surgery

The purpose of this review is to highlight the pivotal role of nuclear medicine in pediatric surgery, specifically in the diagnosis and management of nephro-urological conditions. This review focuses on the applications and advantages of three key nuclear medicine techniques: Tc-99m dimercaptosuccinic acid (DMSA), Tc-99m diethylenetriaminepentaacetic acid (DTPA), and Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphies. These imaging modalities are crucial for providing detailed anatomical and functional information with minimal invasiveness, essential for evaluating congenital anomalies, urinary tract infections, and obstructive uropathies in children. DMSA Scintigraphy is established as the gold standard for detecting renal cortical scarring and assessing functional renal parenchymal damage. It offers superior sensitivity and specificity compared to other imaging techniques, making it indispensable for identifying renal scars from recurrent urinary tract infections or pyelonephritis. DTPA Scintigraphy is critical for measuring glomerular filtration rate (GFR) and analyzing renogram curves, providing quantitative assessments of renal function. It effectively evaluates renal perfusion and identifies perfusion defects and renal ischemia, essential for managing conditions like renal artery stenosis and unilateral kidney disease. MAG3 Scintigraphy excels in dynamic renal scintigraphy, particularly in patients with impaired renal function. It provides high-quality images and superior diagnostic capability, making it invaluable for assessing ureteropelvic junction obstruction and other obstructive uropathies in pediatric patients. The review concludes by emphasizing the integration of these scintigraphy techniques with SPECT/CT, enhancing diagnostic accuracy and providing comprehensive anatomical and functional insights. Despite concerns regarding radiation exposure, measures such as dose optimization and advanced imaging techniques ensure safety and efficacy in pediatric applications.